Basic Information
| Provider Information | |||||||||
| NPI: | 1306194576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 636 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHELLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310792046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293652570 | ||||||||
| FaxNumber: | 2293652571 | ||||||||
| Practice Location | |||||||||
| Address1: | 636 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHELLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310792046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293652570 | ||||||||
| FaxNumber: | 2293652571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2012 | ||||||||
| LastUpdateDate: | 04/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN180944 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 003127311B | 05 | GA | MEDICAID |